How Optum medical cost savings solutions bring value
- Medical bill review that adaptively integrates with existing systems and maximizes savings
- Clinical & Coding Logic that delivers 8% average additional savings below fee schedule with detailed explanation of review (EOR) for providers
- TrueCourse certified databases that deliver 10–20% additional savings for Wisconsin claims, supplementing PPO savings*
Customized reporting, audit transparency and more
Medical bill review
- Customized bill review rules and negotiations
- Customized claims professional auto-adjudication
- Customized electronic data interchange (EDI) and reporting
- E-bill or paper bill intake
- Fee schedule/usual, customary and reasonable (UCR) application
- Mailroom processing
Clinical & Coding Logic
- Audit transparency and defensibility
- Highly qualified clinical and coding reviewers
- Improper line-level charge identification
- Second-pass audit precision
- State-specific coding edits
TrueCourse (Wisconsin-specific)
- 31 million new records every 6 months
- Gold standard, state-certified pricing data
- Significant reduction in disputes and appeals
- Wisconsin regulatory compliance (Wis. Stats. 102. 16(2) and DWD 80.72)
Other workers’ compensation solutions we offer
Pharmacy solutions
Your injured workers come first. Our pharmacy solutions deliver savings, clinical support and better outcomes — so you can focus on what matters most.
Ancillary services
Our ancillary services are promptly provided to meet your needs. We deliver compassionate, clinically guided support. That means injured workers recover sooner — and you save time and money.
PPO networks
Our PPO networks bring it all together. Procura™, Optum OneNet® and trusted affiliates deliver nationwide coverage with state-specific care.
*TrueCourse is only available for Wisconsin state of jurisdiction claims